Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence

TitleAlcohol interventions in a trauma center as a means of reducing the risk of injury recurrence
Publication TypeJournal Article
Year of Publication1999
AuthorsGentilello, LM, Rivara, FP, Donovan, DM, Jurkovich, GJ, Daranciang, E, Dunn, CW, Villaveces, A, Copass, M, Ries, RR
JournalAnnals of Surgery
Date PublishedOct
Publication Languageeng
ISBN Number0003-4932 (Print)0003-4932 (Linking)
Accession Number10522717
KeywordsAdult, Alcohol Drinking/*adverse effects/epidemiology, Female, Humans, Intervention Studies, Male, Prospective Studies, Recurrence, Risk Factors, Trauma Centers, Wounds and Injuries/epidemiology/*etiology/*prevention & control

OBJECTIVE: Alcoholism is the leading risk factor for injury. The authors hypothesized that providing brief alcohol interventions as a routine component of trauma care would significantly reduce alcohol consumption and would decrease the rate of trauma recidivism. METHODS: This study was a randomized, prospective controlled trial in a level 1 trauma center. Patients were screened using a blood alcohol concentration, gamma glutamyl transpeptidase level, and short Michigan Alcoholism Screening Test (SMAST). Those with positive results were randomized to a brief intervention or control group. Reinjury was detected by a computerized search of emergency department and statewide hospital discharge records, and 6- and 12-month interviews were conducted to assess alcohol use. RESULTS: A total of 2524 patients were screened; 1153 screened positive (46%). Three hundred sixty-six were randomized to the intervention group, and 396 to controls. At 12 months, the intervention group decreased alcohol consumption by 21.8+/-3.7 drinks per week; in the control group, the decrease was 6.7+/-5.8 (p = 0.03). The reduction was most apparent in patients with mild to moderate alcohol problems (SMAST score 3 to 8); they had 21.6+/-4.2 fewer drinks per week, compared to an increase of 2.3+/-8.3 drinks per week in controls (p < 0.01). There was a 47% reduction in injuries requiring either emergency department or trauma center admission (hazard ratio 0.53, 95% confidence interval 0.26 to 1.07, p = 0.07) and a 48% reduction in injuries requiring hospital admission (3 years follow-up). CONCLUSION: Alcohol interventions are associated with a reduction in alcohol intake and a reduced risk of trauma recidivism. Given the prevalence of alcohol problems in trauma centers, screening, intervention, and counseling for alcohol problems should be routine.

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